ArticleMedical care2020
Understanding Geographic Variation in Systemic Overuse Among the Privately Insured.
Article in Medical care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Patient, provider, and system-level factors associated with preoperative cardiac testing: A systematic review.Journal of hospital medicine · 2023Pooled it
- Impact of spatial accessibility to primary care physicians on health care outcomes and costs.International journal of health geographics · 2025Article
- Associations of care continuity and care coordination with the overuse of healthcare services: a nationwide population-based study.BMC health services research · 2024Article
- Development of a disease-based hospital-level diagnostic intensity index.Diagnosis (Berlin, Germany) · 2024Article
- Variation in Low-Value Service Use Across Veterans Affairs Facilities.Journal of general internal medicine · 2023Article
- Reducing Overuse by Healthcare Systems: A Positive Deviance Analysis.Journal of general internal medicine · 2023Article
- Clinical chemistry laboratory test overuse in a cardiology clinic: a single-center study.Journal of medicine and life · 2023Article
- Assessing patient, physician, and practice characteristics predicting the use of low-value services.Health services research · 2022Article
- Characterizing the Relationship Between Payer Mix and Diagnostic Intensity at the Hospital Level.Journal of general internal medicine · 2022Article
- Assessment of Overuse of Medical Tests and Treatments at US Hospitals Using Medicare Claims.JAMA network open · 2021Article
- External Validation of and Factors Associated with the Overuse Index: a Nationwide Population-Based Study from Taiwan.Journal of general internal medicine · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
Abstract
backgroundMedical care overuse is a significant source of patient harm and wasteful spending. Understanding the drivers of overuse is essential to the design of effective interventions.
objectiveWe tested the association between structural factors of the health care delivery system and regional differences systemic overuse. RESEARCH
designWe conducted a retrospective analysis of deidentified claims for 18- to 64-year-old adults from the IBM MarketScan Commercial Claims and Encounters Database. We calculated a semiannual Johns Hopkins Overuse Index for each of the 375 Metropolitan Statistical Areas in the United States, from January 2011 to June 2015. We fit an ordinary least squares regression to model the Johns Hopkins Overuse Index as a function of regional characteristics of the health care system, adjusted for confounders and time.
resultsThe supply of regional health care resources was associated with systemic overuse in commercially insured beneficiaries. Regional characteristics associated with systemic overuse included number of physicians per 1000 residents (P=0.001) and higher Medicare malpractice geographic price cost index (P<0.001). Regions with a higher density of primary care physicians (P=0.008) and a higher proportion of hospital-based providers (P=0.016) had less systemic overuse. Differences in hospital and insurer market power were inversely associated with systemic overuse.
conclusionsSystemic overuse is associated with observable, structural characteristics of the regional health care system. These findings suggest that interventions that aim to improve care efficiency via reductions in overuse should focus on the structural drivers of this phenomenon, rather than on the eradication of individual overused procedures.
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Registered trials
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